UTILIZATION AND CASE MANAGEMENT
Streamline healthcare processes and prioritize patient care
Optimize resource utilization, ensure quality care, and stay compliant with regulations! Have a dedicated team that guarantees proper support to patients without unnecessary and costly interventions.
Discover Personalized Healthcare Staffing
Our approach to Utilization Management and Case Management support is not a one-size-fits-all solution. Instead, we focus on understanding your requirements to match and hire a dedicated team of talented, board-certified Registered Nurses (RNs) who align perfectly with your organizational needs.
- Medical Billing
- Appointment Scheduling
- Healthcare Support/Patient Support
- Claims Processing
- Medical Transcription
- Healthcare Data Analytics
- Clinical Documentation
- Insurance Utilization Review
Utilization Management
Utilization Management (UM) aims to ensure that patients receive appropriate and necessary medical services while controlling costs and maintaining quality. With CORE, you can ensure that your team consists of qualified experts committed to enhancing patient care and aligning with evidence-based practices and clinical guidelines.
Medical Record Review
UM RNs meticulously review patient records to assess medical service necessity, aligning with medical guidelines and standards.
Insurance Authorization and Appeals
RNs liaise with insurers, obtaining pre-authorizations and appealing denials with documented justifications.
Cost Containment
Nurses manage costs by identifying unnecessary services and advocating for efficient, cost-effective, and quality treatment.
Collaboration and Coordination
UM nurses work with providers to develop care plans, prioritizing patient needs and ensuring efficient use of medical services.
Regulatory Compliance
They ensure healthcare delivery meets regulatory standards to avoid penalties and maintain quality care.
Quality Improvement
UM nurses analyze data on healthcare delivery, identifying areas for improvement, to enhance patient care and satisfaction.
Case Management
Case Management (CM) involves providing personalized support and guidance to patients throughout their healthcare journey across various settings. By partnering with CORE, you gain access to a diverse pool of healthcare professionals and assemble a specialized team capable of addressing the unique challenges of each patient case.
Patient Assessment
CM RNs gather comprehensive health information to create individualized care plans for new patients.
Care Management and Coordination
They develop patient-specific care plans, coordinating medical appointments, therapies, and community resources.
Patient Education and Advocacy
CM nurses educate patients and families on conditions, care plans, and available resources, advocating for their needs.
Interdisciplinary Collaboration
Nurses collaborate with healthcare professionals to ensure cohesive patient care.
Transition and Discharge Planning
CM RNs assist with discharge planning, ensuring smooth transitions to home or another level of care.
Monitoring and Follow-Up
RNs monitor patient progress, adjust care plans, and conduct follow-up assessments to ensure ongoing needs are met.
Provide Enhanced Care with the Right Team
As the healthcare landscape evolves and demands increase, it's easy for essential administrative duties like utilization and case management to be overlooked. However, by entrusting these tasks to a skilled team through CORE, healthcare providers can refocus their attention on delivering outstanding patient care while ensuring full compliance with regulatory standards and guidelines.
Ensure the best patient care with an excellent team
Every patient deserves the highest level of care, and that starts with assembling the right team. With CORE, you can customize your team by selecting board-certified RNs who meet your criteria in patient care and fit seamlessly into your team. Rest easy knowing that you're delivering top-notch healthcare!
Deliver quality care with peace of mind
With a team of experts upholding high healthcare delivery and practice standards, you can ensure quality and compliance in patient care. Trust in UM/CM support team to stay up-to-date on regulations and guidelines, allowing you to focus on providing the best care possible.
Effortlessly hire and scale your team
With CORE, you can streamline the hiring process and have the flexibility to scale your team as needed. Our expert support services ensure that you can provide top-notch healthcare services, while saving you time and resources.
Ongoing support beyond staffing
Our partnership doesn't end with staffing. We support your team's integration, ongoing development, and success. From ensuring smooth onboarding to facilitating continuous education and professional growth opportunities, CORE is dedicated to the long-term success of your healthcare team.
Frequently Asked Questions (FAQs)
Partnering with an EOR like CORE for healthcare staffing provides employers with a comprehensive solution to streamline processes and prioritize patient care. By outsourcing administrative tasks related to utilization and case management to a dedicated team, employers can ensure that healthcare resources are utilized efficiently, minimizing unnecessary interventions and optimizing patient outcomes. This allows healthcare providers to focus on delivering high-quality care without being burdened by administrative complexities, ultimately leading to improved patient satisfaction and loyalty.
Personalized healthcare staffing is integral to improving utilization and case management for employers by tailoring the workforce to meet specific organizational needs. Rather than adopting a one-size-fits-all approach, CORE focuses on understanding the unique requirements of each employer, enabling them to match and hire a team of RNs who possess the necessary skills and expertise. This customized approach not only enhances resource utilization but also ensures that patients receive individualized care that aligns with their healthcare needs and preferences, ultimately driving better clinical outcomes.
Entrusting utilization and case management tasks to a skilled team through an EOR like CORE offers several benefits for healthcare providers. Firstly, it allows employers to leverage the expertise of professionals who specialize in these areas, ensuring compliance with regulatory standards and guidelines. Moreover, by offloading administrative burdens to a dedicated team, healthcare providers can allocate more time and resources towards delivering exceptional patient care, enhancing overall efficiency and effectiveness within the organization.
Employers can trust in CORE’s support services to source professionals well-versed in industry best practices and regulatory requirements, ensuring compliance and adherence to standards. With these, employers can have confidence in their ability to navigate complex regulatory landscapes effectively, mitigating risks and safeguarding the integrity of their operations.
A dedicated team of talented RNs plays a critical role in enhancing patient care and satisfaction by providing personalized, compassionate, and evidence-based care. These professionals serve as trusted advocates for patients, ensuring that their needs are met and their concerns are addressed effectively. By fostering strong relationships with patients and their families, RNs can improve communication, promote health literacy, and empower patients to take an active role in their healthcare journey.
Explore answers to other questions you may have about CORE or Employer of Record by clicking below.
Take your healthcare services to the next level!
Trust us to provide you with a professional team so you can focus on providing the best healthcare possible.
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